Guidelines for Complications of Cancer Treatment Vol VIII Part B

The new endoprosthesis then was inserted and the wound wasclosed over a surgical drain. Intravenous antibiotics again werecontinued until the cultures taken at the time of the operationbecame available. Oral antibiotics were continued until allindices of infection (temperature and erythrocyte sedimentationrate) had returned to normal. After the second-stage procedure,the patients were allowed to begin full weightbearing after 48hours and joint movement was allowed when the wound wasseen to be healing.In most of the infections with a cemented endoprosthesis theimplant will be loose or there will be inevitable spread ofinfection along the bone-cement interface, therefore, removalof the implant and the bone cement is essential. In anuncemented implant like KMFTR or HMR system, infectionmay not track along the bone-prosthesis interface and theremay be scope for not removing the prosthesis or doing a onestagerevision. Holzer et al 31 reported on 18 patients with amean followup of 52 months treated by one-stage revisionsurgery without removing the intramedullary stem and hadsuccess in 14 of 18 patients. Their success rate at 6 monthswas 77.8%, somewhat lower than in two stage revision, butproblems with late recurrence of infection do not seem to havearisen in their series. This approach of one-stage revisionsurgery with preservation of the prosthesis in infected hipreplacement was condemned by Crockarell et al 32 who foundthat by 6 years the success rate had fallen to 14%, comparedwith an optimistic figure of greater than 80% after 6 months.Prolonged followup is essential to confirm the success of anyprocedure for infection, and early results can be misleading.A significant incidence of late reinfection is linked to previousradiotherapy or additional operative procedures for revisionor servicing the endoprosthesis.Reinfection of a revised endoprosthesis is generally disastrous.Grimer et al in their series 29 reported that four of the seven112